The clinical approach to chronic cough

Chronic cough remains a significant clinical challenge, affecting approximately 10% of the population and leading to significant impairment in psychological, social and physical quality of life. In recent years, efforts have intensified to elucidate the mechanisms underlying chronic cough and to focus on investigating and treating refractory chronic cough (RCC). A 'treatable trait' approach, which focuses on identifying and addressing the specific associated causes of chronic cough, has gained traction. In some patients, refractory chronic cough is likely driven by a neuropathic mechanism due to dysregulation of the neuronal pathways involved in the cough reflex, often clinically described as cough hypersensitivity syndrome. While the initial treatment of underlying conditions remains central to managing treatable traits, the therapeutic options for RCC have expanded to include targeting cough hypersensitivity. First-line treatments now include neuromodulators and speech therapy with one P2X3 receptor antagonist (gefapixant) recently licensed in the EU, UK and Japan. Despite these advances, patient responses remain variable, underscoring the ongoing need for research into the pathophysiology and treatment of RCC. This article reviews current investigations and management options in treating chronic cough and RCC.